Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Clolistimethate sodium, via DME
Low
$0
Average
$57
Median
$14
High
$254
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
30 payers; the 90th percentile is 621.4× the 10th. Each bar is a price range and its height is how many payers fall in it. Hover a bar, or a row in the ladder, for details.
Filter by billing methodology
Filter by billing class
| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Humana fee schedule · outpatient · +6 other terms | 68 | $2 | $10 | $35 | 366% | — | $0 – $171 |
| 2 | Blue Cross Blue Shield facility · fee schedule · outpatient · +7 other terms | 32 | $0 | $82 | $119 | 145% | — | $0 – $485 |
| 3 | Molina facility · case rate · outpatient · +6 other terms | 29 | $171 | $148 | $61 | 41% | — | $78 – $308 |
| 4 | UnitedHealthcare fee schedule · both · +12 other terms | 26 | $0 | $0 | $0 | 18% | — | $0 – $1 |
| 5 | Anthem facility · case rate · outpatient · +5 other terms | 15 | $182 | $199 | $47 | 23% | — | $124 – $308 |
| 6 | Caresource facility · case rate · outpatient · +1 other terms | 15 | $185 | $199 | $46 | 23% | — | $124 – $314 |
| 7 | Aetna fee schedule · outpatient · +8 other terms | 14 | $1 | $26 | $59 | 224% | — | $0 – $163 |
| 8 | Optum facility · case rate · outpatient · +1 other terms | 13 | $164 | $171 | $57 | 33% | — | $74 – $279 |
| 9 | Bcbs Mn fee schedule · outpatient · +3 other terms | 12 | $1 | $1 | $0 | 57% | — | $0 – $1 |
| 10 | First Health percent of total billed charges · outpatientfrom % of charges · +3 other terms | 11 | $0 | $10 | $32 | 315% | — | $0 – $130 |
| 11 | Medica fee schedule · outpatient · +4 other terms | 10 | $1 | $1 | $0 | 24% | — | $0 – $1 |
| 12 | Aetna Better Health facility · case rate · outpatient · +1 other terms | 7 | $93 | $93 | $2 | 2% | — | $89 – $93 |
| 13 | Amerihealth Caritas facility · case rate · outpatient · +3 other terms | 7 | $86 | $87 | $3 | 3% | — | $86 – $93 |
| 14 | Carefirst percent of total billed charges · outpatientfrom % of charges · +2 other terms | 7 | $0 | $0 | $0 | 35% | — | $0 – $0 |
| 15 | Cigna Healthspring percent of total billed charges · outpatientfrom % of charges | 7 | $0 | $0 | $0 | 35% | — | $0 – $0 |
| 16 | Magellan percent of total billed charges · outpatientfrom % of charges | 7 | $0 | $0 | $0 | 35% | — | $0 – $0 |
| 17 | Phcs percent of total billed charges · outpatientfrom % of charges · +2 other terms | 7 | $0 | $0 | $0 | 35% | — | $0 – $0 |
| 18 | Tricare percent of total billed charges · outpatientfrom % of charges | 7 | $0 | $0 | $0 | 35% | — | $0 – $0 |
| 19 | Superior Healthplan percent of total billed charges · outpatientfrom % of charges | 4 | $1 | $3 | $6 | 172% | — | $0 – $15 |
| 20 | Bcbs Ks fee schedule · outpatient · +1 other terms | 3 | $2 | $2 | — | — | — | $2 – $2 |
| 21 | MultiPlan percent of total billed charges · outpatientfrom % of charges · +1 other terms | 3 | $4 | $4 | $1 | 23% | — | $2 – $4 |
| 22 | Wellmark facility · case rate · outpatient | 3 | $290 | $254 | $80 | 32% | — | $118 – $320 |
| 23 | Kaiser fee schedule · both · +3 other terms | 2 | $1 | $1 | — | — | — | $1 – $1 |
| 24 | Medicaid facility · case rate · outpatient | 2 | $78 | $78 | — | — | — | $78 – $78 |
| 25 | Bcbs Nj percent of total billed charges · bothfrom % of charges | 1 | $76 | $76 | — | — | — | $76 – $76 |
← Hospitals reporting HCPCS S0142 · Snapshot 20261112T181611Z-3fa9fb76